Sober Science.

It’s OK that You Don’t Understand.

11 July 2016

I had a sadly frustrating conversation yesterday in which a naive young man asserted that alcoholism is caused by “society”. He seemed to think that the onset of alcoholism coincides with “life getting too hard” and that that is “society’s fault”. That if “society were fixed” then “becoming alcoholic in the first place” could be “prevented”. Now, these assertions fall into that vague category of being so absurd, nonsensical, and nebulous as to not even be wrong. Something has to be coherent before it can be wrong.

But it’s worth examining anyway. First of all, I hope it’s obvious that alcoholism and the circumstances of a sufferer’s life are unrelated. Alcoholism hits rich and poor, every race, gender, ethnicity, and background. Alcoholism is a disease which is at least partly heritable, and does not discriminate on socioeconomic status. It is a mental illness with both physical and genetic components. If alcoholism is more frequently diagnosed among poorer people (and I don’t know if it is or it isn’t) then I guarantee the discrepancy is at the diagnosis level, not the incidence level. The rich simply have more resources available to prevent consequences of alcoholism like homelessness.

So while this person was woefully misguided about what alcoholism is and what causes it – and further about what is an isn’t society’s responsibility regarding the difficulty of life – the are coming from a good place: they want to find ways to prevent people from suffering the effects of alcoholism. That’s nice. And their lack of understanding isn’t relevant to the niceness, or probably even the ability to work towards, that goal.

Some days it seems that the people who least understand the realities of living with alcoholism, whether the alcoholic is in recovery or not, are the medical professionals and scientists who study the disease. The more I learn about how people study alcoholism from a neurochemical perspective, the more I am convinced that as interesting as this pursuit is, it will never produce meaningful approaches to relieving the suffering of alcoholics.

Similarly medical interventions. Now, obviously, I received, benefitted from, and endorse medical intervention in the early, detoxification phase of sobriety. Detox can be lethal. Medicine and doctors save our lives in this stage. But medicine has very little to offer the alcoholic when it comes to staying sober in the long term. In fact, generally, medical approaches will, I believe, derail sobriety more often than they aid it. We alcoholics love to drink, and to blame others for our continuing to drink. And a doctor whose treatment “fails us” is an excellent scapegoat.

That doesn’t make the doctor responsible for our continuing to drink. They merely get recruited into our disease as a way to convince ourselves that drinking is an acceptable option for us. Similarly, “society” – whatever that means – cannot be responsible for our inebriation. It can at worst be a scapegoat we employ to justify our drinking.

This naive young man’s description is precisely what I’ve heard from so many alcoholics still in denial about what they are and what they need to do: “My life got to hard,” they wail. “If your life was like mine, you’d drink too.” You can hear this over and over again from alcoholics who continue to drink, as well as from those of us who’ve recovered describing our once-drunken selves. We love to blame society for our drinking. We recover, if we ever do, when we stop blaming others and recognize that our disease and our behavior combine to compel us to drink.

Science and medicine have, perhaps implicitly recognizing that they have little to offer the alcoholic, changed the definitions of alcoholism. You won’t find that word in the scientific or medical literature anymore. They prefer “alcohol abuse” and “alcohol dependence”. But changing the words, they redefine what it means to help us; they try to make their interventions look better by reporting “decreased abuse”, as if my life is better when I binge three times a week instead of four. As if I’m healthier in mind and body if I suffer cravings after a day rather than an hour.

The only help that we alcoholics truly need from “society” is to stop viewing alcoholism as a symptom of a moral weakness and a tendency to indolence. If there were fewer barriers to summoning the courage it takes to walk in to your first meeting and ask for help, I think a few more of us might recover. Maybe.

But make no mistake: most of us die. Most of us will always die. And regardless of any magic pill or revolutionary treatment, most of us will continue to die. Because most of us prefer alcohol to life. And you can’t cure that. And it’s not society’s fault. And it’s not medicine’s fault. And it’s not science’s fault. It’s our fault. And it’s the fault of nature and luck.

It’s OK if you don’t agree. Because it’s OK if you don’t understand. We alcoholics don’t need your understanding or your guidance to recover. If you want to help, hold us to the same standards you would anyone else. Don’t condemn those of us in your lives who still drink as moral cowards. But don’t excuse our behavior because we have a disease. You have the right not to participate in our illness. Recognize you can’t cure us. And then let us know that getting help is not weakness, that recovered alcoholics can do anything normal people can.

“Society” – whatever that is – cannot prevent alcoholism. But it can welcome those of us who return from it. And in so doing, may encourage a few more of us to do so.

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Is it your contention, then, that the actuaI incidence of alcoholism (as opposed to the diagnosis) is the same across cultures and historical time periods? Cause I’m pretty sure that’s not true. I might be misinformed, but let’s take the example of alcoholism among native Americans. Isn’t it higher than the white population? And if so, do you ascribe that entirely to genetics? You think it has absolutely zero to do with life circumstances? I would disagree very strongly with that. Certainly there is a hereditary component – but alcohol and drug abuse can sometimes be a (not very effective) coping mechanism. Recognizing that people self-medicate as a response to adverse circumstances is not the same as excusing alcoholism or abdicating responsibility.

Certainly I don’t argue it’s uniform: different populations have different genetics, access, and traditions. And no, it has much to do with life circumstances, but that’s not the same as saying circumstances are responsible. And it’s a VERY far cry from saying “society” is responsible.